Wednesday, April 22, 2015

Recently a patient brought his daughter, a 4th year medical student, to the appointment with him. She nervously asked me about making her imminent, and bizarre, leap from medical student to doctor. She felt like someone was going to tell her she wasn't really qualified to be a doctor, that her whole 4 years of med school were some sort of trick, and that she was really a fraud.

And... I agree. Not that she's a fraud, but that it's how I think most of us feel at that point. Actually, it's how ALL of us feel. It's just that some won't admit it. I will.

Attention medical students and residents: THIS IS NORMAL. You just don't realize it until you're actually going through it.

As a 3rd year medical student this terrified me. I was seeing REAL (OMG! REAL!) PATIENTS and had no idea what I was doing. The attendings would point out the substantial gaps in my knowledge and I'd feel like there was absolutely no way in hell I'd ever know that much.

Toward the end of my 3rd year was a rotation with Dr. Griffith, an absolutely brilliant internist. He was a nice guy, but always made me feel like I knew little, simply because he had all the answers I didn't. Seated next to him at an end-of-year lunch, someone pointed out to him that he'd now been an attending for 6 years (yeah, in retrospect, he's not that much older than me). I quietly asked him "and do you still feel like you don't know anything?" He laughed and said "I don't know anything."

And, folks, it never goes away. I've now been an attending physician for over 15 years, much longer than Dr. Griffith was at that time. And I still feel like I don't know anything.

I think the issue is that inwardly we're still the same people who went to college, made it through medical school, survived residency... but we're still ourselves. Somehow we expect that, by being given the title of "Doctor" we're suddenly endowed with a sort of medical omniscience... and it doesn't happen. I don't feel any smarter today than I did when I stepped out of grade school, or high school, or college. Even though I KNOW that through learning and training I've amassed a decent amount of medical knowledge, it's not something that any of us is consciously aware of.

In my experience, the only way any of us realize how far we've come is when we compare ourselves to someone at a previous stage in our training. When I have the occasional medical student or resident spend a few days with me, I'm amazed at how much more I know about neurology than they do, even though I don't feel any different than I did at their stage. It's only in comparison to those behind us that we realize how far we've come.

And, if they ask me if I ever feel like I don't know anything, I tell them "always."

Wednesday, April 15, 2015

One of my patients is dying from a brain tumor. He has severe pain from a number of related and unrelated issues, and since I'm the doctor he sees the most I've ended up prescribing his narcotics.

Recently, though, his pain has been worsening, and nothing I've given him is touching it. I've tried increasing pill strength and changing narcotics, to no avail.

Because of his severe pain, I finally admitted him directly to the hospital, to try and get things under control with injectable narcs while I decided on the next step. As always, I told his wife to bring in his pill bottles for me to review.

Sitting in the room with them yesterday, I began making my usual notes on what pills, how many were left in each bottle, etc., to make sure he was taking them correctly. As I opened one narcotic bottle after another I found that, in spite of different labels, they all contained the same white tablets with the same number stamped on them.

So I took out my phone to look up the number.

All the bottles were full of generic Tylenol. No wonder nothing touched his pain.

Further investigation revealed his daughter, who was the one picking them up, was selling the pills and replacing them with Tylenol before taking them to her elderly parents.

Thursday, April 9, 2015

In the early 90's I got a coveted med school rotation at a major American medical academic center.

The main reason I was selected over other applicants is that there weren't any. At the time of year I applied for, no sane person would be anywhere near that city. So I was the only medical student. Half their staff, for that matter, left town that month, too.

In fact, the only reason I went there is because my grandparents lived in the area at that time, so I could stay with them.

They also didn't have any residents rotating that month. Or fellows. So I, Ibee Grumpy, 4th year medical student... was it.

Because of this surprising circumstance, they gave me an actual pass to park in THE DOCTOR'S LOT. I mean, I do that now, all the time. But back then this was SOMETHING BIG. Like the executive bathroom. Normally, at most schools, med students aren't allowed to park anywhere that isn't at least a 30 minute walk away, going through a neighborhood where heavily armed police are afraid to patrol.

Needless to say, I was excited. I didn't have the world's best car, but it was nice and in good shape. It was a white 1988 Mercury Cougar, and I was close enough to my teen years that I washed and waxed it regularly.

Unfortunately, while driving to that city I sideswiped a guardrail, and smashed in the side. Since it was now impossible to open the driver's side door, the Cougar went to the dealer's repair shop. Where I was told it would be a few weeks because the staff was on vacation, my insurance was a bitch to work with, I didn't have the money to make it a rush job, etc.

Fortunately (or unfortunately) my grandfather had just given up his driver's license, so didn't need his car anymore. In fact, he'd been getting ready to sell it, including getting a fresh paint job. He graciously told me it was mine for the duration of the visit.

Unfortunately, it was a 1977 Chrysler LeBaron.

Now, these days I'm not a car snob. Having a job and kids can do that to you. So now I drive around in a 2000 Maxima with the passenger side smashed in.

Back then, however, I was a low-grade car snob. Part of being a teenage boy in America is going through a car-crazy phase, which I did. For a few years I read Motor Trend religiously every month, and knew obscure details about every make & model built. Today I don't even know them about my own car.

But I digress. Back to the story.

For those of you too young to remember, a feature of the era was a chain of low-cost auto body shops named "Earl Scheib." They were known for these ads (which, at the time, were everywhere).

In my grandparent's city, the franchise was known for that ad being the bait. When you showed up, you found the deal price only applied to a handful of truly hideous colors that no one in their right mind would want. If you actually desired a halfway decent paint scheme, you had to pay a lot more. The place also had a tendency to overspray paint on places it normally wasn't found, like windshields, chrome trim, tires, dashboards, seat belts, vinyl roofs, headlights, and innocent bystanders.

Anyway.

In trying to spruce up the car to sell it, my grandfather took it to Earl Scheib, and just picked out the cheapest color. The fact that he was color-blind likely didn't help.

So the LeBaron was yellow.

Not just plain yellow, but Earl Scheib extra-glossy electric-neon-flourescent-banana-can-be-seen-from-the-space-shuttle yellow.

It looked like an irradiated taxi on the way to a demolition derby.

"It's like, 'how much more yellow could this be?' and the answer is 'None. None more yellow.'""

The car, as I discovered, also had a tendency to backfire, quite loudly, at random intervals.

And, one morning 25 years ago, I pulled this contraption into the doctor's parking lot at a prestigious, internationally renowned, medical center. As I tried to find a space without anything on either side (I was terrified of scratching some VIP's car) it backfired twice, causing the well-dressed specialists walking into the building to drop and hide behind concrete walls (a reasonable precaution in that area).

I parked there the next morning, too.

On my second day I was told that "due to an administrative error" I'd been given a pass to the wrong lot, and had to park in the medical student's lot, 8 blocks a way, in a high-crime area, behind a dumpster, down by the river.

Not having any choice, I did so.

In an area with a high rate of car theft and vandalism, The LeBaron went untouched during my entire rotation. Except for someone writing "Yellow POS" in the dirt on the back window.

Tuesday, April 7, 2015

I wanted to thank you for your "Health Tips" article yesterday on pelvic lymph node dissection for prostate cancer. The graphic you featured, in particular, was quite helpful:

"What's that noise? Frank Netter rolling over."

Now, I have to admit I'm over 20 years removed from anatomy class, and being a neurologist don't really deal with dem lymph node thingies too much.

But, to the best of my recollection, the area shown in your pic is NOT (unless you're Linda Lovelace) where you'll generally find the pelvic lymph nodes, regardless of whether or not you possess a prostate.

I wasn't too sure, though. I mean, medicine is a field that's constantly changing, so I asked a friend who's an OB/GYN, since I figured she deals with that area (though not for prostate issues) more than I ever will. Her response (after "Are you fucking kidding me?") was: "Along the iliac veins." That's medicalese for "they're in the pelvis, you dork. Duh."

I also like your phrase "doors of the prostate." Honestly, I'm not sure how to take that. While I own a prostate, I've never really thought of it in terms of having doors, windows, or pretty much any other standard features of building architecture.

There's also your use of the word "unfold" to mean "spread" or "metastasize." It makes it sound like cancer is really a form of malignant laundry (although my colleague Webhill insists that all laundry is malignant).

For that matter, I wasn't sure about the way the rest of the article was written, either. While your writer appears to be using a pen name, I have to wonder who's really dictating the text.

Wednesday, April 1, 2015

Recently, Marie's 8th grade girls basketball team won their division's state championship. It was the first time Wingnut School had ever won a state title of any sort. And what recognition did they get?

Zero. Zilch. Zip. Nada. Nothing.

Now, I'm not expecting a parade, or a call from the governor (generally only death row inmates want the latter). I mean, this is just 8th grade. But some acknowledgement outside the team (and us proud parents) would be nice.

In the morning announcements, where they routinely read off scores from boys sports (basketball, baseball, jacks, team scrabble) and upcoming chess club matches, were the girls winning the state tournament even mentioned? Nope.

When the boys basketball team vanquished their arch rival, Lockjaw Middle School 34-32, Wingnut put up a banner the next morning and had a pep rally over lunch. The girls beat Lockjaw 63-40, and weren't even mentioned in the announcements. Or school paper. Or PTA bulletin. Or pretty much anything.

The boys finished the season 8-6, their first non-losing season in 8 years (though didn't make the playoffs), and this fact was announced several times on the school's Twitter account, with pictures. The girls were undefeated at 14-0, and then swept the division's playoffs 6-0. The only time the school mentioned them on the Twitter account all year was before the season even started, to show them trying on their newly redesigned jerseys (which the parents paid for).

The sad part is that the people responsible for this sexist ignorance don't even realize what they're doing. It's 3 secretaries and a vice-principal who write up the morning announcements and plan events. The Principal herself doesn't want to be bothered with such trivial things.

I called and complained yesterday, and was told that a banner about the championship would be hung in the gym "sometime over the summer, when maintenance gets a chance." When school isn't in session.

Of course, they're not alone.

A few times each summer I take Marie and drive the few hours to see the nearest WNBA team play. I think the games are great. Personally, I'd say they're as exciting and competitive as the NBA, with a lot more teamwork and fewer ego conflicts. If you enjoy basketball, and haven't seen a WNBA game, I'd go.

But the same issues are there. The arena is maybe half-full, in spite of the quality of the play. Maybe Americans, by nature, just don't care about women's sports. For a country that often tries to pride itself on equality, women's basketball is far more popular elsewhere. The vast majority of WNBA players work year-round, playing here in the Summer and overseas the rest of the year to earn a living.

Not to mention salaries. In the NBA, pretty much the league minimum is $900,000 per year. And that goes to the guy who rides the bench all season.

In the WNBA? One of the league's biggest stars, Diana Taurasi, makes... $107,000 a year. While certainly not a small amount, Ms. Taurasi is actually taking the 2015 season off from her WNBA team to play in Russia for $1.5 million. And who can blame her?

It's sad to see that, at age 13, my daughter is already learning how much the accomplishments of a talented group of young women can mean. Which is, apparently, not much.

Welcome to my whining!

This blog is entirely for entertainment purposes. All posts about patients may be fictional, or be my experience, or were submitted by a reader, or any combination of the above. Factual statements may or may not be accurate.

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